Background: Different factors regulate the insulin level in blood. Earlier C-peptide was considered as by product of insulin biosynthesis and its role in body seems to be negligible. C-peptide at low physiological concentrations mimics the effects of insulin. However, in the presence of elevated level of insulin concentrations concomitant raised level of C-peptide may blunt peripheral effects of insulin age. This study was carried out to verify the age, sex, and BMI wise variation in level of C-peptide among apparently healthy individual and its contribution in fine-tuning of the tissue’s metabolism under different physiological conditions. Methods: This is a prospective cross-sectional observational study. Estimation of serum c-peptide level was done by solid phase direct sandwich enzyme linked immunosorbent assay (ELISA) kit method. Glucose is estimated by Glucose oxidase peroxidase (GOD-POD) end point colorimetric method and HbA1C was estimated by ion exchange resin method (kit method). Result: Serum C-peptide level is significantly high in advance age and males in compared to younger age and females respectively. The mean level of serum C-peptide is higher in higher body mass index (BMI) group compared to lower, but this difference is statistically insignificant. Conclusions: In normal subjects, the level of C-peptide shows positive correlation with age and BMI. Males have higher level of C-peptide in comparison to females. Apart from these variation C-peptide contributes to different biological effects.
背景：调节血液中胰岛素水平的因素多种多样。早先，C 肽被认为是胰岛素生物合成的副产品，在体内的作用似乎微乎其微。低生理浓度的 C 肽能模拟胰岛素的作用。然而，在胰岛素浓度升高的情况下，同时升高的 C 肽水平可能会削弱胰岛素年龄的外周效应。本研究旨在验证表面健康的人体内 C 肽水平在年龄、性别和体重指数方面的变化，以及它在不同生理条件下对组织新陈代谢的微调作用。研究方法这是一项前瞻性横断面观察研究。采用固相直接夹心酶联免疫吸附测定（ELISA）试剂盒法测定血清中的 c 肽水平。葡萄糖采用葡萄糖氧化酶过氧化物酶（GOD-POD）终点比色法估算，HbA1C 采用离子交换树脂法（试剂盒法）估算。结果：高龄男性的血清 C 肽水平明显高于低龄女性。体重指数（BMI）较高组的血清 C 肽平均水平高于体重指数较低组，但差异在统计学上不显著。结论正常人的 C 肽水平与年龄和体重指数呈正相关。男性的 C 肽水平高于女性。除此以外，C肽还能产生不同的生物效应。
{"title":"Study of age, sex and body mass index wise variation in C-peptide level among urban population of Northern part of Bihar","authors":"Rajeev Kumar, Indu Priyadarshini, Alka Goyal, Swarnim Swarn, Sude Kumar Singh","doi":"10.18203/2349-3933.ijam20233885","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233885","url":null,"abstract":"Background: Different factors regulate the insulin level in blood. Earlier C-peptide was considered as by product of insulin biosynthesis and its role in body seems to be negligible. C-peptide at low physiological concentrations mimics the effects of insulin. However, in the presence of elevated level of insulin concentrations concomitant raised level of C-peptide may blunt peripheral effects of insulin age. This study was carried out to verify the age, sex, and BMI wise variation in level of C-peptide among apparently healthy individual and its contribution in fine-tuning of the tissue’s metabolism under different physiological conditions. Methods: This is a prospective cross-sectional observational study. Estimation of serum c-peptide level was done by solid phase direct sandwich enzyme linked immunosorbent assay (ELISA) kit method. Glucose is estimated by Glucose oxidase peroxidase (GOD-POD) end point colorimetric method and HbA1C was estimated by ion exchange resin method (kit method). Result: Serum C-peptide level is significantly high in advance age and males in compared to younger age and females respectively. The mean level of serum C-peptide is higher in higher body mass index (BMI) group compared to lower, but this difference is statistically insignificant. Conclusions: In normal subjects, the level of C-peptide shows positive correlation with age and BMI. Males have higher level of C-peptide in comparison to females. Apart from these variation C-peptide contributes to different biological effects.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"134 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233888
Subhash M. Kale
India is the world's center for diabetes, with an estimated 77 million adults over the age of 18 having type 2 diabetes and nearly 25 million are pre-diabetics. Approximately 15-20% of diabetic patients will suffer from diabetic foot ulcer at least once in their lifetime which can also lead to deformity and amputation if timely intervention is not done. The presence of at least two classic signs of inflammation or purulence is the basis of clinical diagnosis of diabetic foot infection and it usually presents with mono/polymicrobial etiology. The surgeon must know the course of the infection, principles of non-healing wound management, and biomechanics of the foot for an optimal outcome. We described 2 case reports who presented with non-healing infected wounds. Healing was achieved through multidisciplinary team approach, patient education about diabetes, off-loading regime and regular wound dressing using Theruptor Novo.
{"title":"Theruptor Novo, a novel wound dressing in the management of infected diabetic foot ulcer: two case reports","authors":"Subhash M. Kale","doi":"10.18203/2349-3933.ijam20233888","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233888","url":null,"abstract":"India is the world's center for diabetes, with an estimated 77 million adults over the age of 18 having type 2 diabetes and nearly 25 million are pre-diabetics. Approximately 15-20% of diabetic patients will suffer from diabetic foot ulcer at least once in their lifetime which can also lead to deformity and amputation if timely intervention is not done. The presence of at least two classic signs of inflammation or purulence is the basis of clinical diagnosis of diabetic foot infection and it usually presents with mono/polymicrobial etiology. The surgeon must know the course of the infection, principles of non-healing wound management, and biomechanics of the foot for an optimal outcome. We described 2 case reports who presented with non-healing infected wounds. Healing was achieved through multidisciplinary team approach, patient education about diabetes, off-loading regime and regular wound dressing using Theruptor Novo.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"18 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233889
Abhijit Biswas, Krishnan Ramasubramanian
Health promotion methodology of evolved homeopathy is very useful to achieve near zero disease-levels in the various organs of a person’s body, only for those persons, who are health-conscious and want to continue sincerely with the preventive medicines of evolved homeopathy and digital homeopathy, and occasional GDV (Gas discharge visualization) check-up, as may be necessary. The methodology of evolved homeopathy utilizes medicines of digital homeopathy and evolved homeopathy for prevention and cure, according to the first fundamental-principle of cure (“Prevention is better than cure”). True “nipping in the bud” of any disease from a patient’s body is possible only when the treatment starts based not on a patient’s perception of symptom(s) but on a whole-body diagnostic chart generated by a sophisticated device like the GDV scanner. Based on the experience of the persons who are utilizing the side-effect free preventive and curative medicines of evolved-homeopathy and digital homeopathy for preventing and curing problems of various organs to achieve near zero disease-level, it is clear that the methodology of evolved-homeopathy and digital homeopathy for health promotion, is very effective. It seems evident that for the sincere followers of the three fundamental-principles of cure as detailed below, health promotion methodology of evolved homeopathy and digital homeopathy, is very beneficial. When the condition of near zero disease-levels in the various organs of a person’s body, is achieved, about 20 years age-reduction is felt along with improvement of physical and mental stamina.
{"title":"Good and rapid health promotion by curing diseases of various organs, using digital homeopathy","authors":"Abhijit Biswas, Krishnan Ramasubramanian","doi":"10.18203/2349-3933.ijam20233889","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233889","url":null,"abstract":"Health promotion methodology of evolved homeopathy is very useful to achieve near zero disease-levels in the various organs of a person’s body, only for those persons, who are health-conscious and want to continue sincerely with the preventive medicines of evolved homeopathy and digital homeopathy, and occasional GDV (Gas discharge visualization) check-up, as may be necessary. The methodology of evolved homeopathy utilizes medicines of digital homeopathy and evolved homeopathy for prevention and cure, according to the first fundamental-principle of cure (“Prevention is better than cure”). True “nipping in the bud” of any disease from a patient’s body is possible only when the treatment starts based not on a patient’s perception of symptom(s) but on a whole-body diagnostic chart generated by a sophisticated device like the GDV scanner. Based on the experience of the persons who are utilizing the side-effect free preventive and curative medicines of evolved-homeopathy and digital homeopathy for preventing and curing problems of various organs to achieve near zero disease-level, it is clear that the methodology of evolved-homeopathy and digital homeopathy for health promotion, is very effective. It seems evident that for the sincere followers of the three fundamental-principles of cure as detailed below, health promotion methodology of evolved homeopathy and digital homeopathy, is very beneficial. When the condition of near zero disease-levels in the various organs of a person’s body, is achieved, about 20 years age-reduction is felt along with improvement of physical and mental stamina.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233883
S. Malini, C. Jayakrishnaveni, Saravanakumar Palaniappan
Background: Ageing and depression often coexist, with older individuals experiencing increased depressive symptoms. Factors include substance use, diabetes, cardiovascular disease, and rural elderly populations. This study aimed to assess the validity and performance of depression scales for late-life depression among patients attending the outpatient clinic at the Institute of Mental Health, Chennai. Methods: This prospective study was conducted on 358 patients aged >50 years who reported to the OPD and were diagnosed with depression at the institute of mental health, Chennai. Baseline assessments were done at the time of recruitment into the study, and assessments were done (visit 1) for depression as in assessment tools. Scheduled visits were performed every six months for two years (visits 2-5). Adverse events were monitored and recorded periodically. Results: The study found a significant positive correlation between CSDD, MADRS, and PHQ9 scores with HAMD, MADRS, and GDS. The HAMD had a higher correlation with all depression scales except the Geriatric Depression Scale (GDS). The GDS had a distinct dimensionality and varied items, while MADRS showed a good correlation with all depression scales except GDS. The PHQ9 and MADRS are more valid and accurate among the participants, with higher accuracy, sensitivity, and specificity values. After these two scales, the HAMD was better with higher values than all the other scales. Conclusions: Various depression scales were found to have a strong correlation with each other in measuring late-life depression at a tertiary care psychiatric institution.
{"title":"Late-life depression: assessment of validity and performance of depression scales in patients attending outpatient clinic at the institute of mental health","authors":"S. Malini, C. Jayakrishnaveni, Saravanakumar Palaniappan","doi":"10.18203/2349-3933.ijam20233883","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233883","url":null,"abstract":"Background: Ageing and depression often coexist, with older individuals experiencing increased depressive symptoms. Factors include substance use, diabetes, cardiovascular disease, and rural elderly populations. This study aimed to assess the validity and performance of depression scales for late-life depression among patients attending the outpatient clinic at the Institute of Mental Health, Chennai. Methods: This prospective study was conducted on 358 patients aged >50 years who reported to the OPD and were diagnosed with depression at the institute of mental health, Chennai. Baseline assessments were done at the time of recruitment into the study, and assessments were done (visit 1) for depression as in assessment tools. Scheduled visits were performed every six months for two years (visits 2-5). Adverse events were monitored and recorded periodically. Results: The study found a significant positive correlation between CSDD, MADRS, and PHQ9 scores with HAMD, MADRS, and GDS. The HAMD had a higher correlation with all depression scales except the Geriatric Depression Scale (GDS). The GDS had a distinct dimensionality and varied items, while MADRS showed a good correlation with all depression scales except GDS. The PHQ9 and MADRS are more valid and accurate among the participants, with higher accuracy, sensitivity, and specificity values. After these two scales, the HAMD was better with higher values than all the other scales. Conclusions: Various depression scales were found to have a strong correlation with each other in measuring late-life depression at a tertiary care psychiatric institution.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233884
A. Jadhao, S. G. Vengurlekar, M. P. Shah, S. S. Pathare
Background: Oral glucose tolerance test (OGTT) performed at 24-28 weeks gestation is the current recommended method to the diagnosis of gestational diabetes mellitus (GDM). Many recent studies investigating glycated hemoglobin (HbA1c) in detecting GDM yield different results. There are no published data on HbA1c in the diagnosis of GDM in India. Methods: A cross-sectional study was carried out at T.N.M.C. Mumbai during the period from January to June 2021 to assess the reliability of HbA1c in the diagnosis of GDM. Results: We included 397 pregnant females. The age range of the patients was 18 to 35 years, with a mean of 24.57±11.10 years. The mean fasting blood glucose level was 129.73 mg/dl and the mean 2 hours after 75 g oral glucose level was 188.21 mg/dl. The difference between the two was statistically significant. The Spearman's correlation coefficient (r) between fasting blood glucose and HbA1c was 0.610 (p<0.05) and between postprandial blood glucose and HbA1c was 0.683 (p<0.05). Scatter plots of FBG and 2 hours after 75 g oral glucose with HbA1C shows a positive correlation. Conclusions: This study showed that 2 hours after 75 g oral glucose had a better correlation with HbA1c than fasting blood glucose level. In the absence of HbA1c facility or unreliable HbA1c report, postprandial blood glucose can be a surrogate marker of HbA1c for management and monitoring of gestational diabetes mellitus, but a larger study is needed to confirm this finding.
{"title":"Relationship between glycated hemoglobin and blood glucose levels in fasting and two hours after 75 g oral glucose in gestational diabetes mellitus","authors":"A. Jadhao, S. G. Vengurlekar, M. P. Shah, S. S. Pathare","doi":"10.18203/2349-3933.ijam20233884","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233884","url":null,"abstract":"Background: Oral glucose tolerance test (OGTT) performed at 24-28 weeks gestation is the current recommended method to the diagnosis of gestational diabetes mellitus (GDM). Many recent studies investigating glycated hemoglobin (HbA1c) in detecting GDM yield different results. There are no published data on HbA1c in the diagnosis of GDM in India. Methods: A cross-sectional study was carried out at T.N.M.C. Mumbai during the period from January to June 2021 to assess the reliability of HbA1c in the diagnosis of GDM. Results: We included 397 pregnant females. The age range of the patients was 18 to 35 years, with a mean of 24.57±11.10 years. The mean fasting blood glucose level was 129.73 mg/dl and the mean 2 hours after 75 g oral glucose level was 188.21 mg/dl. The difference between the two was statistically significant. The Spearman's correlation coefficient (r) between fasting blood glucose and HbA1c was 0.610 (p<0.05) and between postprandial blood glucose and HbA1c was 0.683 (p<0.05). Scatter plots of FBG and 2 hours after 75 g oral glucose with HbA1C shows a positive correlation. Conclusions: This study showed that 2 hours after 75 g oral glucose had a better correlation with HbA1c than fasting blood glucose level. In the absence of HbA1c facility or unreliable HbA1c report, postprandial blood glucose can be a surrogate marker of HbA1c for management and monitoring of gestational diabetes mellitus, but a larger study is needed to confirm this finding.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"48 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139165476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233882
J. Alegbeleye, T. Kasso
Background: Early detection of ovarian neoplasms confers a better outcome and prognosis for patients. Although newer diagnostic modalities have been recently developed, the availability and accessibility of complete blood count parameters make it a convenient and cost-effective marker for malignancy. Objectives were to evaluate the diagnostic accuracy of pretreatment neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with late-stage epithelial ovarian malignancy at the University of Port Harcourt Teaching Hospital. Methods: A prospective analysis of fifty-seven women with histologic diagnosis of epithelial ovarian cancer who were managed at the University of Port Harcourt Teaching Hospital between January 1, 2018, and December 31, 2022, was conducted. A data collection form was used to obtain socio-demographic and clinico-pathological characteristics from the patients after informed consent was obtained. Pretreatment levels of NLR and PLR were determined from complete blood count. The Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive accuracy of the haematological parameters for late-stage epithelial ovarian cancer. Results: Higher values of NLR and PLR were significantly associated with the stage of ovarian cancer (p=0.001). The optimal cut-off points based on ROC curve analyses for NLR and PLR were found to be 2.6 (AUC=0.61, p>0.05), and 155.8 (AUC=0.62, p>0.05) respectively. However, none of the haematological parameters could be used as predictive markers for advanced-stage ovarian cancer in this study. Conclusions: Pretreatment NLR and PLR cannot be used as a stand-alone predictor of advanced ovarian cancer, and should be correlated with other clinical, laboratory and radiologic parameters.
{"title":"The diagnostic value of systemic inflammatory response markers as predictors of epithelial ovarian cancer","authors":"J. Alegbeleye, T. Kasso","doi":"10.18203/2349-3933.ijam20233882","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233882","url":null,"abstract":"Background: Early detection of ovarian neoplasms confers a better outcome and prognosis for patients. Although newer diagnostic modalities have been recently developed, the availability and accessibility of complete blood count parameters make it a convenient and cost-effective marker for malignancy. Objectives were to evaluate the diagnostic accuracy of pretreatment neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with late-stage epithelial ovarian malignancy at the University of Port Harcourt Teaching Hospital. Methods: A prospective analysis of fifty-seven women with histologic diagnosis of epithelial ovarian cancer who were managed at the University of Port Harcourt Teaching Hospital between January 1, 2018, and December 31, 2022, was conducted. A data collection form was used to obtain socio-demographic and clinico-pathological characteristics from the patients after informed consent was obtained. Pretreatment levels of NLR and PLR were determined from complete blood count. The Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive accuracy of the haematological parameters for late-stage epithelial ovarian cancer. Results: Higher values of NLR and PLR were significantly associated with the stage of ovarian cancer (p=0.001). The optimal cut-off points based on ROC curve analyses for NLR and PLR were found to be 2.6 (AUC=0.61, p>0.05), and 155.8 (AUC=0.62, p>0.05) respectively. However, none of the haematological parameters could be used as predictive markers for advanced-stage ovarian cancer in this study. Conclusions: Pretreatment NLR and PLR cannot be used as a stand-alone predictor of advanced ovarian cancer, and should be correlated with other clinical, laboratory and radiologic parameters.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"35 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233886
S. Malini, C. Jayakrishnaveni, Saravanakumar Palaniappan
Background: Late-life depression in older adults can cause reversible cognitive impairment, often resulting in pseudo-dementia. Cognitive impairment can lead to executive dysfunction, reduced flexibility, and difficulty thinking and decision-making. This study aimed to assess the validity and performance of cognitive scales in late-life depression among patients attending the outpatient department of the institute of mental health, Chennai. Methods: This prospective study included 360 patients aged >50 years who were diagnosed with depression and attended the OPD at the institute of mental health, Chennai. Baseline assessments were performed at the time of recruitment into the study (visit 1), and scheduled visits were performed every six months for two years (visits 2 to 5). Unscheduled visits were done every month, and adverse events were monitored and recorded periodically Results: Among 59 patients, 53.1% were female, 32.2% were diabetic, and 93.9% were experiencing subjective working difficulties. The Montreal cognitive assessment scale classified 51.4% as moderate, while the ADAS-cog and ACE scales classified 86% and 99.7%, respectively, as having abnormal mental status. However, a significant correlation and discrepancy between scores were observed for scales such as ACE, ADAS-cog, standardised mini-mental status examination, and Montreal cognitive assessment scale. A strong correlation was found between ACE, MMSE, MoCA, and ACE; however, FAST showed a significant negative correlation. The MoCA was strongly correlated with the MMSE, ACE, ADAS-cog, and Mini-Cog, indicating good alignment with the FAST. Conclusions: Cognitive scales strongly correlate with late-life depression in patients, suggesting an improvement in assessment, evaluation, and treatment to address cognitive deficits.
{"title":"Validity and performance of cognitive scales in elderly patients with depression in a tertiary care hospital in Chennai","authors":"S. Malini, C. Jayakrishnaveni, Saravanakumar Palaniappan","doi":"10.18203/2349-3933.ijam20233886","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233886","url":null,"abstract":"Background: Late-life depression in older adults can cause reversible cognitive impairment, often resulting in pseudo-dementia. Cognitive impairment can lead to executive dysfunction, reduced flexibility, and difficulty thinking and decision-making. This study aimed to assess the validity and performance of cognitive scales in late-life depression among patients attending the outpatient department of the institute of mental health, Chennai. Methods: This prospective study included 360 patients aged >50 years who were diagnosed with depression and attended the OPD at the institute of mental health, Chennai. Baseline assessments were performed at the time of recruitment into the study (visit 1), and scheduled visits were performed every six months for two years (visits 2 to 5). Unscheduled visits were done every month, and adverse events were monitored and recorded periodically Results: Among 59 patients, 53.1% were female, 32.2% were diabetic, and 93.9% were experiencing subjective working difficulties. The Montreal cognitive assessment scale classified 51.4% as moderate, while the ADAS-cog and ACE scales classified 86% and 99.7%, respectively, as having abnormal mental status. However, a significant correlation and discrepancy between scores were observed for scales such as ACE, ADAS-cog, standardised mini-mental status examination, and Montreal cognitive assessment scale. A strong correlation was found between ACE, MMSE, MoCA, and ACE; however, FAST showed a significant negative correlation. The MoCA was strongly correlated with the MMSE, ACE, ADAS-cog, and Mini-Cog, indicating good alignment with the FAST. Conclusions: Cognitive scales strongly correlate with late-life depression in patients, suggesting an improvement in assessment, evaluation, and treatment to address cognitive deficits.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"261 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.18203/2349-3933.ijam20233887
I. K. O. Widiana, Dewi Catur Wulandari
Thyroid storm is an acute and life-threatening condition. Graves’ disease is the most common cause of thyroid storm. In this case, reported an uncontrolled Graves’ disease patient with multiple complications progressing to thyroid storm. A 33-years-old woman was admitted to the emergency department with agitation. Patient had a history of uncontrolled hyperthyroidism four years ago. From physical examination found exophthalmos, bibasilar rales in both lungs, shifting dullness on stomach, swollen feet, and cold extremities. The ECG showed an atrial fibrillation with rapid ventricular response. Thyroid stimulating hormone (TSH) was found very low with 0.02 mIU/L and very high free thyroxine (FT4) with 5.04 ng/dL. The neck USG showed thyroiditis and bilateral neck lymphadenopathy. The patient was hospitalized for 9 days (4 days in ICCU and 5 days in the general ward). A very high thyroid hormone receptor antibody (TRab) of 35.9 signified a diagnosis of Graves’ disease. The patient had a total Burch-Wartofsky point scale (BWPS) score of 80 and highly suggestive of a thyroid storm. Multiple complications of Graves’ disease are cardiac failure, atrial fibrillation, seizures, vomiting, abdominal cramps, diarrhea, elevated liver enzymes, coma, jaundice, and thromboembolism while in this case the patient had cardiac failure, atrial fibrillation, and elevated liver enzymes. Thyroid storm is diagnosed with clinical features not on laboratory results. It is important to evaluate multiple complications of Graves’ disease as an early warning to reduce the mortality of thyroid storm.
甲状腺风暴是一种危及生命的急性病。巴塞杜氏病是甲状腺风暴最常见的病因。本病例报告了一名未得到控制的巴塞杜氏病患者，其多种并发症发展为甲状腺风暴。一名33岁的女性患者因躁动不安被送入急诊科。患者四年前曾患过不受控制的甲状腺功能亢进症。体格检查发现患者眼球外翻、双肺啰音、腹部移位性钝痛、双脚肿胀、四肢冰冷。心电图显示心房颤动并伴有快速心室反应。促甲状腺激素（TSH）很低，仅为 0.02 mIU/L，游离甲状腺素（FT4）很高，为 5.04 ng/dL。颈部 USG 显示甲状腺炎和双侧颈部淋巴结肿大。患者住院9天（4天在重症监护室，5天在普通病房）。患者的甲状腺激素受体抗体（TRab）达到了35.9，诊断为巴塞杜氏病。患者的伯奇-瓦托夫斯基评分法（Burch-Wartofsky point scale，BWPS）总分高达80分，高度提示甲状腺风暴。巴塞杜氏病的多种并发症包括心力衰竭、心房颤动、癫痫发作、呕吐、腹部绞痛、腹泻、肝酶升高、昏迷、黄疸和血栓栓塞，而本例患者则出现了心力衰竭、心房颤动和肝酶升高。甲状腺风暴的诊断依据是临床特征而非实验室结果。评估巴塞杜氏病的多种并发症是降低甲状腺风暴死亡率的早期预警，这一点非常重要。
{"title":"Thyroid storm in an uncontrolled graves’ disease with multiple complications: a case report","authors":"I. K. O. Widiana, Dewi Catur Wulandari","doi":"10.18203/2349-3933.ijam20233887","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233887","url":null,"abstract":"Thyroid storm is an acute and life-threatening condition. Graves’ disease is the most common cause of thyroid storm. In this case, reported an uncontrolled Graves’ disease patient with multiple complications progressing to thyroid storm. A 33-years-old woman was admitted to the emergency department with agitation. Patient had a history of uncontrolled hyperthyroidism four years ago. From physical examination found exophthalmos, bibasilar rales in both lungs, shifting dullness on stomach, swollen feet, and cold extremities. The ECG showed an atrial fibrillation with rapid ventricular response. Thyroid stimulating hormone (TSH) was found very low with 0.02 mIU/L and very high free thyroxine (FT4) with 5.04 ng/dL. The neck USG showed thyroiditis and bilateral neck lymphadenopathy. The patient was hospitalized for 9 days (4 days in ICCU and 5 days in the general ward). A very high thyroid hormone receptor antibody (TRab) of 35.9 signified a diagnosis of Graves’ disease. The patient had a total Burch-Wartofsky point scale (BWPS) score of 80 and highly suggestive of a thyroid storm. Multiple complications of Graves’ disease are cardiac failure, atrial fibrillation, seizures, vomiting, abdominal cramps, diarrhea, elevated liver enzymes, coma, jaundice, and thromboembolism while in this case the patient had cardiac failure, atrial fibrillation, and elevated liver enzymes. Thyroid storm is diagnosed with clinical features not on laboratory results. It is important to evaluate multiple complications of Graves’ disease as an early warning to reduce the mortality of thyroid storm.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"93 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24DOI: 10.18203/2349-3933.ijam20233569
I. G. S. A. J. Kusumadewi, Putu Nindya Ayu Ningrum Subadra, K. Suryana
Gitelman syndrome (GS) is inherited in a recessive manner and is caused by inactivating mutations in the SLC12A3 gene characterized by the loss of salt, leading to hypokalemic metabolic alkalosis with concurrent hypomagnesemia and hypocalciuria. Hypokalemia is defined as a plasma potassium concentration of less than 3.5 mmol/l. A 24-year-old woman came with weakness and numbness in both lower limbs for the past 1 day and later extended to all four extremities. This patient had been admitted to hospital twice in the last 2 months with similar complaints. Laboratory results showed hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis accompanied by elevated eGFR, anemia and increased potassium secretion in the distal tubules. Gitelman syndrome is the rare case and does not have specific symptoms, so the diagnosis depends on the accuracy of high clinical suspicion, especially those experiencing hypokalemia.
{"title":"A rare case: evaluation of chronic hypoklemia in patient with Gitelman syndrome","authors":"I. G. S. A. J. Kusumadewi, Putu Nindya Ayu Ningrum Subadra, K. Suryana","doi":"10.18203/2349-3933.ijam20233569","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233569","url":null,"abstract":"Gitelman syndrome (GS) is inherited in a recessive manner and is caused by inactivating mutations in the SLC12A3 gene characterized by the loss of salt, leading to hypokalemic metabolic alkalosis with concurrent hypomagnesemia and hypocalciuria. Hypokalemia is defined as a plasma potassium concentration of less than 3.5 mmol/l. A 24-year-old woman came with weakness and numbness in both lower limbs for the past 1 day and later extended to all four extremities. This patient had been admitted to hospital twice in the last 2 months with similar complaints. Laboratory results showed hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis accompanied by elevated eGFR, anemia and increased potassium secretion in the distal tubules. Gitelman syndrome is the rare case and does not have specific symptoms, so the diagnosis depends on the accuracy of high clinical suspicion, especially those experiencing hypokalemia.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24DOI: 10.18203/2349-3933.ijam20233566
S. Singh, Rina Singh, S. K. Singh, M. Iquebal, S. Jaiswal, P. K. Rai
Background: Thyrotoxicosis is a common endocrine problem. Sub-classification and rapid diagnosis of disease is crucial in the management. Methods: In this prospective cross-sectional study from India, newly diagnosed thyrotoxicosis patients were enrolled. All patients were sub classified into Graves’ disease, (GD), sub-acute thyroiditis (SAT) and toxic nodular goiter (TNG) based on diagnostic criteria. Clinical features were noted and TT3, TT4 and TSH level were measured. A thyroid scan was also done. Results: TNG, respectively. Mean± SD age for GD, SAT and TNG were 36.88±10.55, 37.44±5.96 and 61±11.36 years, respectively. Most of patients were female (77.63%). Goiter was present in 81.25%, 55.56% and 100% of GD, SAT and TNG patients respectively. Mean TT3/TT4 ratio was higher (20.15±5.45 verses 12.72±0.77) in GD as compared to SAT patients. The area under ROC curve of the TT3/TT4 for diagnosis of GD was 0.964. Cut off level of TT3/TT4 ratio >14.1 offered best sensitivity, specificity, PPV (positive predictive value) and accuracy. Conclusions: This first report from India on sub-classification of thyrotoxicosis shows that GD is the commonest cause of thyrotoxicosis. TT3/TT4 ratio of >14.1 may help in differentiating the cause of thyrotoxicosis.
{"title":"Aetiological sub-classification of thyrotoxicosis and relevance of TT3/TT4 ratio in sub-classification of patients with thyrotoxicosis: an Indian cross-sectional study","authors":"S. Singh, Rina Singh, S. K. Singh, M. Iquebal, S. Jaiswal, P. K. Rai","doi":"10.18203/2349-3933.ijam20233566","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20233566","url":null,"abstract":"Background: Thyrotoxicosis is a common endocrine problem. Sub-classification and rapid diagnosis of disease is crucial in the management. Methods: In this prospective cross-sectional study from India, newly diagnosed thyrotoxicosis patients were enrolled. All patients were sub classified into Graves’ disease, (GD), sub-acute thyroiditis (SAT) and toxic nodular goiter (TNG) based on diagnostic criteria. Clinical features were noted and TT3, TT4 and TSH level were measured. A thyroid scan was also done. Results: TNG, respectively. Mean± SD age for GD, SAT and TNG were 36.88±10.55, 37.44±5.96 and 61±11.36 years, respectively. Most of patients were female (77.63%). Goiter was present in 81.25%, 55.56% and 100% of GD, SAT and TNG patients respectively. Mean TT3/TT4 ratio was higher (20.15±5.45 verses 12.72±0.77) in GD as compared to SAT patients. The area under ROC curve of the TT3/TT4 for diagnosis of GD was 0.964. Cut off level of TT3/TT4 ratio >14.1 offered best sensitivity, specificity, PPV (positive predictive value) and accuracy. Conclusions: This first report from India on sub-classification of thyrotoxicosis shows that GD is the commonest cause of thyrotoxicosis. TT3/TT4 ratio of >14.1 may help in differentiating the cause of thyrotoxicosis.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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